Effect of Conversion from Tacrolimus to Cyclosporine on BK Viremia among Kidney Transplant Recipients: The TACCsA-SWITCH Study
Bibliographic record
Abstract
Background: There is no established treatment strategy for BK-polyomavirus (BKPyV) infection among kidney transplant recipients (KTRs) after initial reduction of immunosuppression. In vitro studies suggest an inhibitory role of cyclosporine on replication of BKPyV. We investigated effect of conversion of tacrolimus to cyclosporine (TAC-CsA switch) on BKPyV viral load (VL) among KTRs. Methods: We conducted a retrospective cohort study with a pre-post study design investigating effect of TAC-CsA switch among KTRs with persistent BKPyV-VL of more than 10,000 IU/ml (equivalent to 4 log10IU/ml) for more than 3 months before TAC-CsA switch. We ensured 6 months of follow up after conversion, between 2020 to 2023. We calculated the slope of change for log-BKPyV-VL in log10IU/ml/month using least-square method and compared the mean results before and after TAC-CsA switch. Results: 32 patients were included in the analysis. 25 (78.1%) patients had deceased kidney transplantation (KT), and 17 (53.1%) patients received anti-thymocyte globulin. Before TAC-CsA switch, 17 (53.1%) had a change of mycophenolate to leflunomide, 4 (12.5%) and 14 (43.8%) were given cidofovir and intravenous immunoglobulin, respectively. Median time from last immunosuppression adjustment/ therapy given prior to TAC-CsA switch was 112.5 (interquartile range (IQR) 225.75) days. At time of TAC-CsA switch, median BKPyV-VL was 321x103 (IQR 2.49x106) IU/ml, equivalent to median log-BKPyV-VL of 5.50 (IQR 1.39) log10IU/ml. The mean slope of change for log-BKPyV-VL before and after TAC-CsA switch were 0.304 (95% confidence interval (CI) 0.139, 0.469) and -0.279 (95% CI -0.353, -0.204) log10IU/ml/month respectively. Mean difference between the slopes before and after TAC-CsA switch was -0.583 (95% CI -0.807, -0.358) log10IU/ml/month (p < 0.001). 21 (65.6%) patients achieved log-BKPyV-VL improvement of at least 0.2 log10IU/ml/month (equivalent to 16 fold VL reduction in 6-month period) after TAC-CsA switch. Conclusion: TAC-CsA switch is a useful strategy for difficult to treat BKPyV viremia among KTRs.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".